Monthly Archives: December 2016

The morning after the American presidential election my son sent me the following message:

“I awoke this morning to a strange new smell of brimstone and a rising temperature.”

That same morning a message from my daughter arrived from Australia: “What the f**k just happened?”

And then she sent me this message after my recent blog on Donald Trump and the possible demise of democracy:

“My dearest father. I appreciate your concern. However, what is done is done and a lone wolf in Canada cannot change the American election results. It is up to the American public to do what is right. Perhaps, as with Reagan many years ago, this new generation of Americans needs Trump to remind them what they had was not so bad and to suck it up and get on with it. We cannot change what has happened. We cannot control what is beyond our control. We can only control our response to it.”

I will have a discussion with her about the “lone wolf” metaphor upon her Christmas visit from Australia. That is, after I give her, her husband and her two children a hug.

Her salutation “My dearest father” must be taken with a grain of salt. Hidden in that phrase may be echoes of Charlotte Bronte, but more importantly, the glee of a daughter in the position of giving wise advice to her “know-it-all” father.

Through this season we will all spend much time together, laughing, talking, arguing, eating, drinking, walking, playing cards. The Australian grandchildren will be introduced to a Canadian winter. I will be reminded poignantly, repeatedly, of what is important in life. I am sure the Ghost of Christmas past will visit occasionally, but we will ignore the ghost of Christmas yet to come.

We will also try to ignore the unfolding American drama. I hope my obsession with Donald Trump will go into remission, at least through Christmas. Though it may require CBT, mindfulness, prayer, alcohol, and the odd rebuke from my daughter.

One of the better contributions made by the major religions of this world is the setting aside of a few days, a few weeks of each year to focus on love, giving, forgiveness, kindness, and hope.

The messages from my son and daughter were about our current anxiety, our shared fear of what might happen over the next four years. But for the moment, for this holiday season, I will take great pleasure and comfort from the fact of those messages. My children are smart, healthy, engaged, and they talk to me.

Some very smart people have been pessimistic about the staying power of democracy.

“When the people find that they can vote themselves money that will herald the end of the republic.” – attributed to several American Statesmen and Politicians.

“The best argument against democracy is a five-minute conversation with the average voter.” – Winston Churchill

“Democracy cannot succeed unless those who express their choice are prepared to choose wisely. The real safeguard of democracy, therefore, is education.” – Franklin D. Roosevelt

“Democracy… while it lasts is more bloody than either aristocracy or monarchy. Remember, democracy never lasts long. It soon wastes, exhausts, and murders itself. There is never a democracy that did not commit suicide.” – John Adams

“Democracy substitutes election by the incompetent many for appointment by the corrupt few.” – George Bernard Shaw

Yet those of us born into, growing up and spending our adult lives within a democracy, assume that with every passing year it will grow stronger, more resilient, and less easy to corrupt. And that would be, I think, the consensus of academics, philosophers, political scientists: that with many safeguards in place, a separation of governance and religion, civilian control of the military, an independent judiciary, a functioning economy, literacy and education, voting rights for all, transparency and openness, a decent and wise constitution – that with these in place democracy can but flourish.

But.

A friend of mine, a fellow medical student at the time, was the son of the first minister of the crown in the British Commonwealth to be convicted of fraud. It was purported to be a $5,000 bribe he accepted from a major corporation. I remember being puzzled by the smallness of the bribe. It seemed a paltry amount upon which to risk one’s career, family, reputation, livelihood. Some have whispered in that time-honoured conspiratorial manner that the $5000 was only the tip of the iceberg and what they could “get him on”. But I have come to understand that our individual sense of entitlement is so strong, so close to the surface, that it can be easily manipulated by the unscrupulous, or simply by our own grandiosity and narcissism. How else can one explain our vaunted Canadian senators hedging their expense accounts? Let’s face it. All it takes is a $50 gift and a letter extolling your brilliance and goodness. Just sign here.

So democracies are fragile. And not just those nascent democracies of Chile, Argentina, Brazil, Venezuela, Turkey. The old, established ones as well.

The foreboding elements are now in place: seriously unequal wealth distribution, increasing tribalism triggered by migration, mass media mechanisms for the dissemination of fake news, and, in the USA, a floundering public education system, competing religious extremes, the inevitable failure of the American Dream for the majority of Americans, a festering and historic racial divide, a warrior culture, a culture that celebrates celebrity above all else, a culture that is skeptical of experts, where many think the facts derived from science are simply opinions, a culture with rather simple notions of “good guys” and “bad guys”, a manipulated information system, and the election of Donald Trump.

Americans are at risk of losing their democracy. We are all at risk of war and economic collapse. I have no idea exactly how these events might unfold but I am sure they have moved from the impossible column to the quite possible column.

As well, it seems, surveys of the populations in several democracies find a growing percentage of people who think an alternative to democracy would be okay. Close to 50 percent say they could live without it. This laissez-faire attitude is especially prevalent among the generations who have only known democracy.

There have been a few moments since the election when it seemed that maybe this will be all right, we will somehow muddle through, when Donald is reported to have said something sensible, conciliatory, inclusive. But, for the most part he remains Donald Trump, and my fears are growing.

I won’t go over all that he has said and tweeted, the inordinate amount of time he has spent focused on petty grievances, watching SNL, celebrating his victory – or on his sketchy appointments, his lack of attendance at briefing sessions, his poking a stick at China and at the findings of his own CIA. But I would like to point out a few things he has said, and the way he has said them. For they are more telling. They are more telling about his level of narcissism, his tone-deafness, his lack of knowledge, and his grandiosity.

At a rally after congratulating himself on being named person of the year by Time Magazine, he commented to the crowd that maybe the title should be returned to “Man of the Year”. Eh? Eh? Apparently the crowd cheered.

When being asked about answering the call from Taiwan, and then questioning why we have a one China policy, he said, “I won’t let China push me around.”

His ignorance is palpable even when he remembers a few catch phrases from a briefing by his people. But in theory he could learn. What is more frightening is the level of his narcissism and grandiosity revealed in those three quotations. This is a Shakespearean level of grandiosity and narcissism, the kind that leads a man to listen only to sycophants, to govern according to his own pleasure, according to his own ego gratification, and to bring the temple crashing down, to lay waste to his nation before accepting any slight, any blow to his over-inflated but fragile sense of self.

I’m afraid I only see three possibilities. The electoral college votes against Trump, precipitates a constitutional crisis, and stokes the American divide, or he is inaugurated, and then impeached, precipitating a constitutional crisis and stoking the American divide, or we all spend the next four years on the brink of nuclear war while watching regressive policies being put in place.

In October, the New England Journal of Medicine published three articles by cardiologist Lisa Rosenbaum. The first is called Liberty versus Need — Our Struggle to Care for People with Serious Mental Illness which contains a section on recovery. The other two articles are listed and linked on the right hand side of that page. Toronto psychiatrist, Dr David Gratzer, brought them to my attention and then I discovered that my friends at Mad In America (MIA) detested the articles so, from both sources, I knew they would be good.

Comments by MIA on the article include:

“This is paternalistic rubbish”

“It is no wonder that people are turning against such white, wealthy elites, as exemplified by recent events such as Brexit and Trump’s election, when so many experts such as this (white, wealthy) psychiatrist think they can impose their view about who is right on common people and their families.”

“The arrogance is a notch higher than you might have realized. The author is a cardiologist.”

Dr Rosenbaum mentions that the Recovery movement began partly to combat stigma by pointing out that US policy makers wanted to show that people could get better. She quotes a 2003 report that said “because recovery will be the common, recognized outcome of mental health services, the stigma surrounding mental illnesses will be reduced, reinforcing the hope of recovery for every individual with a mental illness”

She then quotes psychiatrist/historian, Joel Braslow, stating that “What unifies the (recovery) movement is its self-perception as a radical departure from the past.” Consequently the problem with recovery, she says, is that it becomes antagonistic to and a subtle rebuke of psychiatry. Thus, psychiatrists are seen as having created dependency so that their patients will need them forever. To this she says that “psychiatrists are no more responsible for the chronic needs often associated with schizophrenia, for instance, than medical doctors are for those associated with HIV.”

The needs are there because of the disease and not because of the efforts of those treating the sufferers.

If you defer to the patients’ choice, a positive outcome is guaranteed because success is self-determination. Whatever the patient decides is in his or her best interests is a positive outcome even if objectively, it is not. And she cites recovery maven, Patricia Deegan, who wrote “Although the phenomenon (recovery) will not fit neatly into natural scientific paradigms, those of us who have been disabled know that recovery is real because we have lived it” That reasoning, says Rosenbaum, stifles dissent because who can argue with lived experience.

And she cites Oliver Freudenreich, a German-born psychiatrist who now practices at Massachusetts General Hospital. He pointed out to the author that “It’s a very American idea: if you try hard enough, pull yourself up by the bootstraps, you can do it.”

It is that last statement that bothers me the most because many people cannot recover to the point where they have no deficits and need no medications. Anyone who can’t (and they are in the majority to varying degrees) are made to feel like it is there own fault that they are not better.

Most people are familiar with the concepts put forth years ago by people like Dr Bernie Siegal (Love Medicine and Miracles) and Norman Cousins (Anatomy of an Illness) who talk about curing your diseases with imagery, positive thinking, laughter and relaxation.

These ideas were studied in the case of metastatic breast cancer and there was no improved survival at 5 years. The latest Cochrane metaanalysis concluded that “there is a relative lack of data in this field, and the included trials had reporting or methodological weaknesses and were heterogeneous in terms of interventions and outcome measures.”

A number of years ago, I had the opportunity to meet with a number of women who were involved in one such trial on survival. The most difficult article I’ve ever done because I sat with about 10 women all of whom were terminal and about to die. All of the women told me how desperately they wanted to live and how they hated Bernie Siegal and Norman Cousins. Their philosophy, they said, suggests that if we die from cancer, it will be our fault – that we did not work hard enough to think positive thoughts and to will our cancer away. That is not the case at all. Their will to live was not able to stave off the consequences of advanced metastatic cancer.

Nor is it the case with people with schizophrenia or any other serious mental illness who are not able to throw out their pills and return to good health. Many (or most) will continue to need them and will continue to need support to varying degrees. If they cannot achieve what has been arbitrarily defined as recovery, it will have been their fault. It is not! They should be supported in whatever it takes to keep them as well as they can become.

In a paradoxical fashion, what you are suggesting does not conform with “Canadian Values”. It is, in fact, antithetical to Canadian values.

Besides, you are talking about the wrong thing. Some Canadians value money, others value freedom, love, generosity. Some value the opinions of old religious books. Some value the opinions of Justin Bieber or Oprah. Some value our diversity. Some like to eat the same meal every night. Some abhor meat. Others like to BBQ.

It is really our evolved social contract that you are addressing. Rightfully, you do not want to see it threatened. It is, quite clearly, more evolved and very superior to that of most societies. One can only find its equal in a few other countries.

Although, for each specific facet of our social contract we can usually find at least one other country more evolved. We can always learn something from Australia, The Netherlands, Norway, Denmark….

Importantly, that social contract is, to the extent it can safely be, without undermining the very rights and freedoms we value, codified in law. We can talk trash about one another, but we can’t promote hate. A fine distinction we leave to our very complex court system, our independent judiciary.

Certainly we don’t want to suddenly find ourselves with a situation of fifty-one percent of the population being newcomers who favor Sharia Law. Maybe not even 2%. I don’t want to hear the adoption of Sharia Law debated in my parliament. The concept of cultural relativity (understanding, not necessarily accepting, cultural practices within the context and history of that culture) should be confined to anthropological studies.

But. We need to have faith that our laws and courts will protect our social contract. We need to have faith that our evolved social contract is the envy of the world, and so obviously better than most others that it can resist a few outliers here and there, a few family patriarchs clinging to thirteenth century ideals.

The first generation of immigrants may stick with some outmoded ideas. Our laws prohibit the worst of these being enacted. (After many committee meetings over the years, a female participant would say to me, “Did you notice how Dr. (Indian name here) did not once acknowledge my presence?” )

The next generation evolves quickly, providing they attend our public schools, sometimes becoming more Canadian than I am with my four and five generation lineage.

Kellie, have faith in our values, our social contract, our laws and our forms of governance. They will withstand a few immigrants with little education and some strange beliefs. Their children will attend our schools and become good Canadians.

Your ideas are potentially far more damaging (as are Trump’s) to our “Canadian Values” than any dozen immigrants appalled by same sex marriage, nudity, bare-headed women, and secular education.

All the nations of the world with evolved social contracts and liberal democracies are struggling with this. How do we protect all that we have achieved when a few of many arriving on our shores have very primitive beliefs about sexuality, women, girls, marriage, Gods and eternity?

We teach and we demonstrate. We do not exclude. We have faith that all will conclude, given time and shown acceptance, that it is far better to live this way, in this rich tapestry of safety, respect, kindness, and diversity, than that other way.

Beyond the basic concepts, I’m not all that familiar with post traumatic stress disorder (PTSD) and, as a fan of Canadian General Romeo Dallaire, I got his latest book on that topic. General Dallaire was the commander of the UN Multinational Peace Force in Rwanda at the time of the genocide. I had read his original book on the topic, Shake Hands With the Devil, seen the film and heard him talk when he was on a national book tour promoting his first book.

Dallaire and his men were traumatized by the level of brutality they witnessed in Rwanda and powerless to do much to prevent it. Between April to mid July, 1994, an estimated 500,000 to a million people were butchered in that small African country. Dallaire and his men had front row seats. Not able to prevent it or stop it and with little support from the UN or the international community, they did what they could.

As Dallaire says in his book, he was the commander who set out on what he thought would be an adventure only “to bear witness to the most terrible horrors on earth. I too was responsible for the mission, and therefore bear the responsibilities for the deaths. I too face blame – from others and from myself – for not preventing the atrocities. I, too, live Life-in-Death.”

After his return to Canada, he resumed his normal duties as a staff officer and a frenetic work schedule while experiencing sleep deprivation, flashbacks, nightmares and emotional turmoil until he was given a medical discharge. There were numerous suicide attempts and, at one point, police found him passed out after he spent a night beside the Ottawa River.

Dallaire has devoted his time to bringing to light the events that happened in Rwanda and to helping to eradicate the use of Child Soldiers in conflicts through his charity. I was reminded when I read that in this book of a comment he made when I heard him speak. He mentioned the impact on trained soldiers of facing little kids of 9 and 10 charging at you with automatic assault rifles firing and their realization that if they did not shoot the kids, they would be shot themselves. It took a great deal of resolve to fire and left the soldiers with memories that they could not erase.

When Dallaire was putting the material together for his first book on the genocide, he hired a researcher to help him. The impact of that work resulted in her taking her own life.

While he does have counselling, General Dallaire also takes medications and what he has to say about his pills is relevant for all mental illnesses. He says that some vets refuse pills because they want to fix their real being. His reply is that if you lost a leg, you would use a prosthesis and pills are the prostheses for what’s between the ears.

“If I wasn’t taking my pills, I would be a horrible person – depressed and aggressive, no matter how much therapy I was undergoing.”

A few pages later he says,

“Each night I take my pills, and try to sleep with the hope that I will not awaken amidst the roaming souls who still wander the hills of Rwanda, asking me to join them.”

Interesting too that someone can stave off the effects of the trauma for years before it finally comes crashing through. In one case he mentions, one of his men was able to carry on for 14 years before it impacted him and he committed suicide.

One of Dallaire’s activities is trying to get better understanding and support for the victims and it may be paying off. At this years Remembrance Day Service at the Cenotaph in Ottawa, the chief chaplain for the Canadian military included the victims of suicide in his talk.

Fidel Castro’s death is being mourned in Cuba, celebrated in Miami. Justin Trudeau is being chastised for his praise of Castro. Putin says Castro was a friend. Trump calls him a brutal dictator and he wants to reset the American/Cuban relationship back to 1962.

It is important we remember the history that gave us the man Fidel Castro, be he hero or villain, or a bit of both.

Here is that history in much abridged form:

Cuba was a colony of Spain until 1898. There had been uprisings against colonial rule before but this time America joined in after the war-mongering of the Hearst papers and the mysterious sinking of the Maine in Havana Harbor.

At the Paris treaty (1898) the US paid Spain 20 million dollars for Cuba and the Philippines (400 million in today’s dollars). Cuba became a US colony until 1902. It achieved independence in 1902 but never full and complete independence because the Americans retained veto power over every decision the Cuban government made, the option of military intervention, and, of course, the military base of Guantanamo Bay.

Over the next 50 years Cuba remained feudal in its organization, this time with American landlords and plantation owners. It was transformed into a single crop (not counting tobacco) farming economy depending almost entirely on exports of sugar to the US. American business controlled this one cash crop and American criminals (the mafia) controlled the nightlife in Havana, a playground for the rich and famous. The Cubans themselves, well, they remained poor, without access to education, health care, or stable housing. At least 40 percent were illiterate. The men worked in the fields, the women in the service industries. Batista was the dictator in charge following a military coup in 1952. He was propped up by American politicians, with ties to American business and the Mob. Arthur Miller described Cuba under Batista as “hopelessly corrupt, a Mafia playground, a bordello for Americans and other foreigners.”

Batista was brutal, using torture and executions; he had investments in Florida, greatly enriched himself and his friends before fleeing to the Dominican Republic to join his friend and fellow dictator, Trujillo, as Castro’s small band of revolutionaries approached in 1959.

Peoples, socialist, communist revolutions and insurgencies have occurred throughout Central and South America. Each in response to brutal dictatorships, corruption and poverty. The United States and notably the CIA have managed to undermine, thwart, defeat them all with the exception of Fidel’s revolution in Cuba. Many of these other states returned to military rule, or dictatorships, or seesawed between these and nascent democracies. For some the insurrections have continued for years. On at least two occasions the Americans have overthrown democratically elected governments with socialist leanings to return countries to brutal dictatorships. And they murdered Che Guevera, and another physician trying to redistribute wealth and make education and health care available to all, Salvador Allende.

Today the homicide rate in El Salvador is over 100 per 100,000 people. The same in Guatemala and the Honduras. To put that in perspective that would be over 34,000 murders per year in Canada.

The prison population in Cuba is about 500 per 100,000. In the US it is 700 per 100,000. Canada about 100 per 100,000, The Netherlands, about 50 per 100,000.

The USA tried to undermine and stop the Cuban Revolution many times, notably with the invasion at the Bay of Pigs, and failed.

After the revolution Castro turned to the US to continue buying its one crop, now nationalized. The US said no, broke off relations and trade, embargoed Cuba. With ties suddenly severed with its only market for its one crop, and its source of equipment and medicines gone, Castro turned to Russia. Russia jumped at the opportunity.

Fast forward. There is no question Castro has been brutal in his suppression of dissidents. Cuba is a police state with much surveillance and control. But the literacy rate of Cubans now exceeds that of the rest of the Americas. Cuban people have food, housing, education and medical care guaranteed. They keep their 1950’s era automobiles running. They ride Chinese made bicycles. All the children go to school. Day care is provided. School is mandatory up to grade 9. University is also free. Medical care is of high quality save for the shortage of equipment and supplies and pharmaceuticals otherwise obtained only from the US. The casinos are gone, though private prostitution once again flourishes for the tourists. Private enterprise is creeping back in small ways. Gun violence is almost nonexistent. The crime rate is very low. Far more tourists actually visit the island now than did in the 1950’s.

In Cuba, Mental Health Care is integrated with public health care. Just as we began reforming our mental hospitals, and creating community care in the 1960’s and 1970’s in North America so did Cuba. Only they stayed with the program. Today the Mental Health Care in Cuba is much as we (in the 1970’s) envisioned it should be in Canada.

It is a complex world we live in. Power corrupts. Revolutions don’t usually achieve the high-minded goals expressed in their pamphlets. Our systems of governance are always at odds with the baser instincts and desires of humans.

But here is an interesting question I ask myself: If I were, say, 40 years old and raising a family of three children, and had no delusions of grandeur, fame and wealth, would I rather be (a doctor, labourer, bricklayer, farmer, construction worker, teacher, nurse, child care worker, lawyer, musician, taxi driver, bus driver, shop keeper, butcher, baker, police officer……) in Cuba or the Honduras, the Dominican Republic, El Salvador, Panama, Brazil, Venezuela, Mexico, Colombia….?

My solution for Cuba many years ago was that it become a Canadian Province. That way as it evolves gradually into a full democracy with a mixed economy, free education and health care, and an independent judiciary we might be able to protect it from American excesses and exploitation.